70-671 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1 Permit No: - (Complete in Triplicate) --------------------- Date Issued _9._ .--�b This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: .�.s __ - - CENSUS TRACT -------------- ----------- !OB ADDRE55/LOCATI N .__.______ �- - .�"" --"- r -------- Owner's Name -----------Phone ------------------- ------ ---- - Address City - --------------- Contractor's Name --- ---- W_--- ------- .License # Jai-A Phone installation will serve: Residence Apartment House❑ Commercial:❑Trailer Court ❑ Motel ❑ Other ------------- - Number of living units---------- Number of bedrooms ____________Garbage Grinder __--___.-_-- Lot Size ------ --------- Number --------- i ----- ------------•-----------------Private [� Water Supply: Public System and name --------------- --- --------------------------------------------------- �, / Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ,❑ Clay Loam fL - ' Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- F {Plot pian, showing size of lot, location of system inrelation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) SEPTIC TANK' Size -------- Liquid Depth -------------------------- OQ PACKAGE TREATMENT [ ] TANK![ ] Caacit -- Type ------------ ------- Material----------- ----------- No. Compartments ---------------•------ p Y -------- -- Yp _ 1 Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- LEACHING ------- , LEACHING LINE [ ] No. of Lines ---------------------..- Length of each line------_-_------------------- Total Length ------------.---------------- _De Depth Filter Material ------- ...... Distance _ 'D' Box --------- Type Filter Material --- --------------- p --------------------•--------- ( --- Property Line. _---------- Distance to nearest: Well -------------------------Founda#ion ------------------ - p �'Y -------•-•--- --____ Rock Filled Yes ❑ No SEEPAGE PIT [ I Depth ------------------- Diameter ---------------- Number ------------------ - t Water Table Depth ---------------------------- ----Rock Size --------------------------- Distance to nearest: Well ------------------------------- Prop.-------------------- p• Line ----------------•----- REPAIR/ADDi710N(Prev. Sanitation Permit# ----------.---------------------------------- Date -------------------•--------------) Septic Tank (Specify Requirements) -------- ------------------- ---------------------------------- Disposal Field (Specify Requirements) _________ -- ---- - ea-' ----73-3---- -----------------------------------------=--------------- ------ -------- ---- -- --- - - ------ -------------- (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subiect to ants Compensation laws of California." Signed --_--------------------- -- Owner - ------------ --- - - ---- -- -- ------------------- Title --- ------- n - �� Title 1. - ---------------------------------------- By --------------------------- &u'`�..' (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY fi --- ------------------------------------------- ---------- DATE 3l -------- BUILDING PERMIT ISSUED -------- ---------- ------------ - -------------- ---------- -- ----------------- -------------------DATE --------------------- --------------------- ` ADDITIONAL COMMENTS ----- --------- ------------- - -- ----- ----------- = �---- -- ----------------------- ------------------------ - ----- ------------------------------------- ------------------------------- ----------------------------------------------------------------------------------- ------------------------ -------------------- -r-- - ------------ ---------------------------------------------------------------------------------Date -- -------- -� > � Final Inspection bY= ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. N. 9 1-'68 Rev. 5M. ,